Contemporary Classification of Macular Holes

Stage 0
Oblique Vitreous Traction
Stage 1
Macular Cyst
Stage 2
Early full thickness macular hole
Stage 3
Historical: Fully developed macular hole with complete posterior vitreous attachment,

or

Contemporary: Vitreous may be detached, often with vitreoschisis,
where the outer layer is still attached.3
Stage 4
Fully developed macular hole with complete posterior vitreous detachment (PVD).

Note: In 1988, Gass proposed that tangential traction on the fovea by an attached posterior cortical vitreous was the main pathophysiologic mechanism of the development of an idiopathic macula hole. More recently OCT, not available in 1988, clearly demonstrates that anterior/ posterior traction of the vitreous on the macula is an important factor.4 The recent addition of Stage 0 has expanded the original classification of Gass. Vitreous splitting or vitreoschisis has similarly expanded the original classification.